title: Severe hyperkalemia during cardiopulmonary bypass: etiology and effective therapy.
abstract: Hyperkalemia is considered a medical emergency as it can result in severe disturbances in cardiac rhythm and death. Although many causes of hyperkalemia exist, exogenous red blood cell transfusions are being recognized as the primary perioperative etiology. The authors report a case of severe intraoperative hyperkalemia associated with the use of allogeneic blood products (packed red blood cells), during a surgical mission to a developing country. The patient was undergoing repeat mitral valve replacement with cardiopulmonary bypass (CPB) and developed significant hyperkalemia with a serum potassium value of 9.9 mEq/L. Successful intraoperative therapies were instituted with a gradual reduction in the serum potassium value to 4.8 mEq, which allowed the patient to be weaned from CPB. The authors review the etiology of hyperkalemia in children including its relationship with allogeneic red blood cell transfusions and treatment modalities including specific therapies which can be instituted during CPB.
authors.affiliation: Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Ohio State University, Columbus, OH 43205, USA. vid.martin@nationwidechildrens.org
authors.forename: David P
authors.initials: DP
authors.lastname: Martin
authors.forename: Daniel
authors.initials: D
authors.lastname: Gomez
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
authors.forename: William
authors.initials: W
authors.lastname: Schechter
authors.forename: Carlos
authors.initials: C
authors.lastname: Cusi
authors.forename: Robert
authors.initials: R
authors.lastname: Michler
mesh_terms: D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002648:Child; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D006947:Hyperkalemia / Q000097:blood / Q000209:etiology* / Q000628:therapy; D007431:Intraoperative Complications; D008943:Mitral Valve / Q000601:surgery; D011188:Potassium / Q000097:blood*
chemical_list: D011188:Potassium
keywords: CPB; cardiopulmonary bypass (CPB); cell saver; electrophysiology; mitral valve replacement